Consumer forum directs pvt insurance co to pay Rs 3.75 lakh mediclaim

The Dehradun District Consumer Disputes Redressal Forum has directed a private insurance company to pay a Dehradun-based senior citizen medical claim of Rs 3,75,662, which was denied to him on technical grounds, within a monthGaurav Talwar | TNN | November 30, 2016, 11:56 IST

Observing that the company indulged in “unfair trade practices”, the consumer forum imposed a fine of Rs 10,000 on the insurance firm for causing mental agony to the litigant and an additional sum of Rs 10,000 against litigation expenses.

Sixty-one-year-old Surendra Swami, resident of Vijay park extension, had bought a health insurance policy from a private company on June 1, 2013 which had a cover of Rs 5 lakh.

In November 2015, the complainant fell ill and was admitted to a private super speciality hospital for 15 days. Within days of being discharged, Swami fell ill again and had to be admitted to the hospital for another five days from December 12 to December 17, 2015.

After the litigant filed his medical claim with the insurance company, the company rejected it, saying that lung disease caused by diabetes and hypertension was not covered under the policy.

Swami filed a complaint with the consumer court on May 13, 2016 seeking compensation. The consumer forum headed by chairman Balbir Prasad and member Alka Negi held that the complainant had to undergo mental agony due to company’s unfair trade practices and directed the company to pay the medical claim within 30 days.